What should I do after possible exposure to Ebola virus disease?

Ebola contact: what to do now

Immediately enter active monitoring for 21 days and seek evaluation at an Ebola treatment center if any symptom develops; if symptomatic with suspected Zaire ebolavirus, urgent transfer for IV supportive care and Ebola-directed monoclonal antibody treatment is lifesaving. 1

• Assess exposure risk now

  • High risk: percutaneous/mucous-membrane exposure to blood/body fluids, unprotected direct contact with a symptomatic EVD patient, or handling infectious specimens without proper PPE. Act as below with no delay. 1
  • Lower risk: casual contact without fluid exposure; still monitor 21 days. 1

• For all exposures (prioritizing mortality/QOL)

  1. Do not travel or work in patient-care roles until cleared if high risk; immediately notify public health/occupational health to arrange daily active monitoring for 21 days (temperature twice daily; symptom check for fever, headache, fatigue, myalgias, vomiting/diarrhea, bleeding). Any symptom → isolate and test. 1
  2. If symptoms develop at any time
     • Isolate, avoid all physical contact, don surgical mask; arrange controlled transport to a federally designated Ebola treatment center. Early care lowers mortality. 1
     • Treatment on arrival (Zaire species): aggressive fluids/electrolytes plus FDA‑approved Inmazeb (REGN‑EB3) or mAb114; both reduce death vs control, greatest benefit when given early. Supportive care alone reduces mortality to ~40%, but adding monoclonal antibodies further improves survival. 1
  3. Post-exposure prophylaxis (PEP)
     • No CDC/ACIP guideline endorses routine PEP for contacts in the U.S.; use is investigational. Focus on rapid detection and early therapeutic monoclonal antibodies if illness begins. 1
     • Emerging data suggest targeted PEP with monoclonal antibodies could help high‑risk contacts, but this is not guideline‑adopted; consider only under research/expanded access with public health authorities. 2, 3
  4. Vaccination
     • Pre-exposure: Ervebo (rVSV‑ZEBOV) is recommended only for adults at highest occupational risk (outbreak responders, designated Ebola‑center HCP, BSL‑4 staff). 1
     • Post-exposure vaccination of contacts is not an ACIP recommendation; if in an outbreak setting, follow public health ring‑vaccination protocols. 1
  5. Source species matters
     • Approved vaccines/therapeutics target Zaire ebolavirus; efficacy against Sudan ebolavirus is uncertain—manage with strict monitoring and immediate supportive care; consult public health for trial access. 3

• Key pitfalls to avoid

  • Delayed reporting/monitoring; every day of untreated symptoms raises death odds. 1
  • Assuming prior vaccination obviates monitoring—21‑day monitoring still required after exposure. 1
  • Unprotected caregiving or handling linens/body fluids—use full PPE and avoid sexual contact with survivors unless condoms used per public health guidance due to documented late sexual transmission. 1

• Special situations

  • Pregnancy, breastfeeding, and pediatrics: manage exposures identically; if symptomatic, prioritize early transfer and monoclonal antibody therapy due to high maternal/infant mortality risk. EBOV can persist in breast milk; avoid breastfeeding if symptomatic and isolate pending testing. 1

Next step for you today:

• If you had direct fluid exposure: stop work/travel, call your health department/occupational health now for active monitoring and designated center linkage.
• If any symptom starts: call ahead and go via controlled transport to an Ebola treatment center for immediate evaluation and early monoclonal antibody therapy. 1